Heart failure (HF) is associated with a reduction of skeletal muscle mass. Whey protein isolate (WPI) has been beneficial in increasing muscle mass and strength, in addition to improving body composition. The goal of this research was to evaluate the effect of WPI on the body composition, muscle mass, and strength of chronic HF patients. For this purpose, twenty-five patients of both genders with predominantly NYHA I functional class and a median age of 65.5 (60.5–71.0) years were used to conduct a randomized, single-blind, placebo-controlled clinical trial and received 30 g per day of WPI for 12 weeks. Anthropometric measurements, body composition analysis, and biochemical exams were performed at the beginning and end of the study. An increase in skeletal muscle mass was observed in the intervention group after 12 weeks. A reduction in waist circumference, body fat percentage, and an increase in skeletal muscle index was observed when compared to the placebo group. No significant effect on muscle strength was observed after 12 weeks of intervention. These data demonstrate that WPI consumption contributed to the increase of skeletal muscle mass, strength, and reduction of body fat in HF patients.

Endothelial dysfunction is a well-known component of the pathophysiology of heart failure (HF), with proven prognostic value. Dietary supplementation with whey protein (WP) has been widely used to increase skeletal muscle mass, but it also has vascular effects, which are less understood. This study aimed to evaluate the effects of WP supplementation on the systemic microvascular function of HF patients. This was a blinded, randomized, placebo-controlled clinical trial that evaluated the effects of 12-week WP dietary supplementation on systemic microvascular function, in patients with HF New York Heart Association (NYHA) classes I/II. Cutaneous microvascular flow and reactivity were assessed using laser speckle contrast imaging, coupled with pharmacological local vasodilator stimuli. Fifteen patients (aged 64.5±6.2 years, 11 males) received WP supplementation and ten patients (aged 68.2±8.8 years, 8 males) received placebo (maltodextrin). The increase in endothelial-dependent microvascular vasodilation, induced by skin iontophoresis of acetylcholine, was improved after WP (P=0.03) but not placebo (P=0.37) supplementation. Moreover, endothelial-independent microvascular vasodilation induced by skin iontophoresis of sodium nitroprusside, was also enhanced after WP (P=0.04) but not placebo (P=0.42) supplementation. The results suggested that dietary supplementation with WP improved systemic microvascular function in patients with HF.

Heart failure (HF) is an important public health problem, considered a new epidemic with high morbidity and mortality. The progression of HF often determines weight reduction, muscle mass loss, and reduced physical ability. Whey protein supplementation may increase the effects of exercise on strength and muscle mass, in addition to promoting improved endothelial function, body composition and quality of life. However, studies are needed to evaluate its benefits in patients with HF. This is a double-blind, randomized, placebo-controlled clinical trial in which patients with HF will be randomly allocated to two groups to receive supplementation with whey protein or placebo, associated with supervised exercise, for 12 weeks. The frequency of exercise will be three times a week. The study variables will be evaluated at baseline and 12 weeks. The main outcome will be maintenance of muscle mass and strength. Microvascular reactivity, quality of life, and inflammatory parameters will be evaluated as secondary outcomes. HF is associated with severe loss of muscle mass and strength, directly contributing to exercise intolerance and inability to maintain daily life activities, becoming a strong predictor of reduced quality of life and mortality. The results of this study will add to the evidence base for providing new dietary recommendations. ClinicalTrials.gov, ID: NCT03142399 . Registered on 29 May 2016. Effect of Whey Protein’ Supplementation and Exercise in Patients with Heart Failure (PROT-HF).

Background/Objectives: Familial hypercholesterolemia (FH) is an increasingly common inherited disorder that increases cardiovascular risk. Despite the importance of lifestyle interventions, adherence to a healthy diet among individuals with FH remains suboptimal. This pilot, multicenter, double-blind, placebo-controlled randomized trial aimed to evaluate the feasibility and preliminary effects of a culturally adapted cardioprotective diet (DICA-FH), alone or in combination with phytosterol and/or krill oil supplementation, on lipid parameters in Brazilian adults with probable or definitive FH. Methods: Between May and August 2023, 58 participants were enrolled across nine Brazilian centers and randomized (1:1:1:1) into four groups: DICA-FH + phytosterol placebo + krill oil placebo; DICA-FH + phytosterol 2 g/day + krill oil placebo; DICA-FH + phytosterol placebo + krill oil 2 g/day; and DICA-FH + phytosterol 2 g/day + krill oil 2 g/day. Interventions lasted 120 days. The primary outcomes were mean low-density lipoprotein cholesterol (LDL-c) and lipoprotein(a) (Lp[a]) levels, as well as adherence to treatment at follow-up. Secondary outcomes included mean levels of other lipids, frequency of adverse events, and assessment of protocol implementation components. All data were presented separately for the allocation groups: phytosterol vs. placebo and krill oil vs. placebo. Results: Mean age was 54.5 ± 13.7 years, and 58.6% were women. Both adherence to protocol (91.8% attendance; 79.1% investigational product intake) and retention (86.2%) were high. No significant differences between groups were found for LDL-c or Lp(a). However, regardless of allocation to active supplementation or placebo, a significant reduction in Lp(a) concentrations was observed following the DICA-FH intervention (median difference: −3.8 mg/dL [interquartile range: −7.5 to −1.2]; p < 0.01). Significant reductions in oxidized LDL (LDL-ox) and LDL-ox/LDL-c ratio were also observed in the overall sample (p < 0.01). Although not statistically significant, all groups showed improvements in diet quality after 120 days. No serious adverse events related to the interventions were reported. Additionally, most protocol implementation components were successfully achieved. Conclusions: The DICA-FH strategy, with or without supplementation, was safe and well-tolerated. Although not powered to detect clinical efficacy (which is acceptable in exploratory pilot trials), the study supports the feasibility of a larger trial and highlights the potential of dietary interventions in the management of HF.

Contextualization: Lifestyle changes, such as smoking cessation, physical activity, and healthy eating, are essential for the treatment and prevention of cardiovascular diseases. The 2021 update of the European Society of Cardiology (ESC) guidelines highlights the need to investigate the adherence to the Mediterranean diet in patients who have suffered acute myocardial infarction (AMI). Objective: The aim of this study was to investigate the adherence to the Mediterranean diet and dietary 2021 ESC guidelines of individuals who have suffered AMI and to evaluate the sociodemographic and lifestyle factors associated with the adherence. Methods: A cross-sectional study was conducted using baseline data from participants prior to enrollment in the DICA-NUTS multicenter clinical trial. The dietary intake was assessed using a food frequency questionnaire and 24 h dietary recall. The nutrient intake was compared with the nutritional recommendations of the 2021 ESC guidelines, and the adherence to the Mediterranean diet was analyzed using a Mediterranean diet score. Furthermore, the analyses of the factors associated with the Mediterranean diet score and 2021 ESC were performed. Analyses were conducted using Stata Data Analysis and Statistical Software version 15.0. Values were considered statistically significant when the p-value < 0.05. Results: Among 488 participants aged ≥ 40 years, moderate adherence to the Mediterranean diet was observed obtaining an average of nine points, with a low intake of vegetables, fish, and cereals. The protein intake was adequate with 18% (interquartile range [IQR] 15.0–23.1) of the total energy value, and the saturated fat intake was high with 9.7% (IQR 7.3–12.7) of the total energy value, while the carbohydrate and total fat intake was adequate. According to the 2021 ESC guidelines, the fiber intake was low with more than 79% of the sample consuming less than 30 g per day. The multivariate analysis using the 2021 ESC dietary recommendations showed that older age (≥60 years) [odds ratio (OR) = 1.63; 95% confidential interval (CI) = 1.44–1.91], never smoking (OR = 1.34; 95% CI = 1.17–1.65), and higher education (OR = 1.37; 95% CI = 1.17–1.77) were correlated with an increased fruit and vegetable intake. Non-white, never-smokers, and former smokers were more likely to consume fish. The alcohol scores were higher in older age participants and women. The dairy scores increased with older age, while the cereal scores decreased. No significant association was found for legumes. Conclusions: According to the scores used, the diet of these individuals moderately reflects the Mediterranean characteristics. Analyzing the 2021 ESC dietary recommendations, the studied population was inadequate. This study found different factors associated with an adequate food intake in post-AMI patients. The highlight of this study was that older age is more likely to increase fruit, vegetable, and dairy intake.

Cardiovascular diseases (CVD) are currently the leading cause of mortality worldwide. Several risk factors contribute to its development and among the modifiable ones, the main ones are related to lifestyle behaviors, such as smoking, physical activity, and diet. In individuals undergoing secondary cardiovascular prevention, promoting a healthy lifestyle is a strategy for reducing the recurrence of events.– However, gaps in adherence to a healthy lifestyle in secondary prevention may be related to the low integration between behavior change and traditional